Abstract
Depression is highly prevalent and has been consistently linked to increased physical ill-health. One common feature of depression is the tendency to interpret everyday events in a negative manner, known as negative interpretation bias. Cognitive bias modification (CBM) is an evidence-based digital treatment that corrects this negative interpretation bias by using a set of scenarios to force a positive interpretation. This approach, however, presents a risk of overcorrecting thoughts, specifically toward unrealistic positivity a safety issue of CBM that has been undetermined. Unrealistic positivity is associated with several negative consequences like misguided hope, low self-esteem, disappointment, and regret. Here, we provided empirical evidence of this overcorrection issue.
We adopted a pre-post test study design with outcome measures of interpretation bias, thought distortion, mood, and performance tasks. Random sampling was used to recruit participants from the community (N = 134; 23.5 Mean age; 101 Female; 19 Māori), who were then randomized into one of the three CBM training groups, where participants thoughts were modified either in a) a negative direction, b) a neutral/positive direction, or c) an overly (unrealistically) positive direction. Quantile regression was used to test significance.
Results revealed changes in interpretation bias after adjusting for baseline interpretation bias scores that are consistent with the direction of the training (all P < .001). That is, relative to other training groups, participants in the overly positive training group showed higher unrealistic positivity; neutral/positive group showed more positive thinking; and negative training group revealed more negative thinking. Other post-training measures pertaining to unrealistic though patterns provided converging evidence of findings (unrealistic optimism scale, P = .04).
Our findings demonstrate the importance of monitoring safety of digital mental health interventions, specifically concerning the overcorrection of thoughts in CBM treatment. The results add to the dearth of studies in this area.